Most area pharmacies selling overdose antidote

Saturday

Dec 2, 2017 at 8:59 PMDec 2, 2017 at 10:51 PM

Rudi Keller @CDTCivilWar

Three months after a new law designed to keep overdosing addicts alive took effect, almost every pharmacy in Columbia is selling or intends soon to sell naloxone, also known under the brand name Narcan, to anyone who can afford it.

The Tribune visited or called several companies or institutions operating pharmacies in Columbia. The prices quoted range from $3 to cover the copay for Medicaid recipients to $165 without any insurance for the nasal applicator with two doses. The lowest cash prices were $70 at Sam’s Club, which also would require a membership, and $109.99 with a coupon at CVS in Target.

Insurance could lower the price, depending on deductibles and other terms.

Naloxone is a fast-acting drug that overcomes opioid overdose and can awaken an unresponsive patient in a minute or less. An opioid overdose kills by suppressing breathing. The law gave Randall Williams, director of the Missouri Department of Health and Senior Services, authority to issue a statewide standing order allowing the sales, which otherwise could require a prescription.

In Boone County this year, eight people died of opioid overdoses through Oct. 31. The toll could have been much higher — through early November, Columbia firefighters had administered naloxone 17 times and the University of Missouri Hospital emergency room had administered it 38 times.

Laura Kingsley, a partner at Kilgore’s Medical Pharmacy, said her company was operating under Williams’ order at all three locations.

“As a public health issue, we support the naloxone initiative of making it available to everyone,” she said. “We have seen doctor’s offices actually prescribing it for patients, but it was pretty much a no-brainer.”

The state Board of Pharmacy surveyed its licensees in late July and August and found that just under one-fourth were already selling naloxone under a 2016 law allowing physicians to set up a protocol for individual pharmacies. About 30 percent of the respondents that weren’t selling it before the law took effect Aug. 28 reported they intended to do so, the survey showed, and 50 percent were unsure. About 1-in-5 reported that they did not intend to sell naloxone under the order.

The order signed by Williams, a physician, requires education for those who request naloxone. Walgreens provides a two-page sheet listing signs of an opioid overdose, how to administer the drug and warnings that the addict, once revived, could relapse into unconsciousness and need a second dose. The sheets also warn that naloxone can cause withdrawal symptoms once the overdose victim is revived.

If a future director is not a physician, the law allows the department to contract with a doctor to continue the order.

“If you’re 14 years old and you are worried about your 18-year-old brother dying in his room with the door closed, you can go in and get Narcan and we’re very proud of that,” Williams said at Wednesday’s opioid summit in Columbia.

The law also grants immunity for drug or paraphernalia possession charges, minor in possession of alcohol charges and probation or restraining order violations for calling 911 to save an overdosing friend. It does not grant an exemption from arrest and prosecution for outstanding warrants or more serious charges.

“We know that 80 percent of people who use narcotics usually use them with other people, yet when first responders get there, 80 percent of the time they are found alone,” Williams said. “We don’t want anyone to die alone because somebody’s afraid they are going to get in trouble.”

The pharmacy board and the Missouri Pharmacy Association are sponsoring training sessions on naloxone and the standing order that will provide continuing education credits needed for license renewals, said Kimberly Grinston, executive director of the board.

“We are excited about the potential for the new authority to be part of the solution here,” she said.

There are discussions underway about reducing the price.

“The $150 is kind of the price range we were wrestling with,” said Ron Fitzwater, executive director of the pharmacy association.

The efforts include persuading suppliers to cut the wholesale price and obtaining a foundation grant to underwrite the cost, he said. A screening program would be used to make sure the naloxone is given to people who couldn’t otherwise afford it and a program is being developed for the southwest part of the state, hit especially hard, he said.

Fitzwater said he was surprised at the lack of negative response when he first took the idea of sales without a prescription to his board.

“I thought I would get a little bit two years ago when I took it to our executive committee,” he said. “When we met in the capital in 2016, our president jumped all over it and said we wanted to help.”

The law passed that year allowed individual pharmacies to set up a protocol with a physician to dispense naloxone.

Standing orders, sometimes called treatment protocols, are most commonly used by pharmacies to dispense vaccinations. They can also give a pharmacist authority to adjust medications for conditions such as diabetes or high blood pressure.

The training sessions emphasize that the pharmacist should do more than just sell the naloxone, Fitzwater said.

“Rather than just send a mailing out, we want to go out and meet with as many of them face to face and tell them what to look for, how to educate the patients,” Fitzwater said. “If it is a loved one or caregiver, we show how to talk to them to try to get them in some kind of treatment program. It kind of uses the pharmacist as a health coach for the patient.”

Pharmacist Alex Smith of Flow’s Pharmacy said his stores will not sell naloxone under the standing order. It is best dispensed by trained personnel, he said, because of several dangers.

“The Narcan thinks it is going to be a miracle cure, that people bounce back and will be fine,” he said.

For some overdose cases, multiple doses are required, he said. And once it works, there are other dangers.

“If a person is passed out or in respiratory depression, it displaces the drug chemically in the central nervous system, replaces it with Narcan and when they get that Narcan they are going to go into immediate withdrawal,” he said.

The only Columbia pharmacy associated with a grocery or other chain retailer that isn’t currently selling naloxone is operated by Schnucks and that will change soon, company spokesman Paul Simon said.

“We are working through procedures, guidelines and training,” he said. “We want a consistent policy across the stores. I don’t have a date but it will be in the near future.”

rkeller@columbiatribune.com

573-815-1709

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